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Just been told I need ACDF

I'm new here, I just received a call yesterday (Saturday) form my neurologist who reviewed by cervical MRI. He told me that I'll need ACDF as soon as possible and to be expecting a call from the surgeon office on Monday to review and schedule the surgery. He said that I have a spinal compression down to 3mm and the neurologist himself had ACDF when he had spinal compression of 5mm. I'm guessing the worst compression is smaller amount of 3mm. My wife and I are pretty shaken by this, we are generally pretty health in our mid 30s.

A quick background....I fell off the deck last year August; about a 3-4 foot drop; but all was fine after a couple of weeks. At first fingers numbness started in April and I went to the chiropractor for lower back pain; than my fingers numbness got worst and stop seeing him in lat May. Than I went to the neurologist and he recommended MRI. By the time I was going to schedule the MRI, I felt better, I had more sensation in my fingers, so I told them I felt better and not needing a MRI. I had a scheduled follow up with the neurologist a month later, they told me the result of my EMG was not good and should really get a MRI. That's pretty the background of the story; I have a two month old and a 6 year; I don't really want surgery...I don't really have any pain, I have good strength in all my limps, actually feeling pretty health. I only have numbness in the finger tips and left leg sometimes feel numb too.

I've been reading/Googling a lot about this and find myself back on this forum. Seem like there are many of you have similar experiences. Since I don't have pain, I'm not sure if ACDF is necessary? What do you all think?


  • If your spinal canal is reduced down to 3mm I expect you will have cord compression.
    Any spinal canal less that 13mm is classes as too small. If you think how big 3mm is, that is the only space that your spinal cord and fluid and ligaments has. It is bound to be compressed, and even if there is no pain, if left I suspect that you will end up with spinal cord injury.

    I am sure this is why they are saying that you need ACDF as soon as possible. Do you have any symptoms at all?
    Tingling, numbness, weakness, balance issues, clumsy hands, stiff legs?

    What level is your ACDF going to be, and is it just one level?

    I have compression at C3/4 and C4/5. I haven't been told of the size of the canal, but I do know that from birth I have a small canal. I have measured my canal on the MRI (I don't really know what I am doing!) and at the tightest point it looks like it is just under 5mm. I do get all sorts of symptoms, and have been told that I will need to have surgery at some point. My husband's question of isn't it better to just get on with it rather than wait for the symptoms to get worse, was answered with 'absolutely'. I have been told that the surgery is done to stop the progression of symptoms rather than to get rid of them, and that I may be left with the symptoms that I have.

    I know and understand what a difficult decision this is and how scary the thought of spinal surgery on your neck is. I hope that others will be along to share their experience with you, and that this will help you in your decision.
    Please do let us know what you decide and when your surgery is, if you do go ahead with it.

    This is a great place for support and information while you are leading up to surgery and then while you are in the recovery stage.

  • You really need to get a 2nd and even 3rd opinion...(The Neurosurgeon that the Neurologist is recommending counts as one)

    Since you are not having a lot of pain and have good feeling in your extremities...I, personally, would not have a fusion.

    I have had 3 of them and they were only done when I had extreme pain....severe herniations that were causing great loss in feeling and there was a threat of paralysis.

    Most everyone starting at age 25-30 starts having degenerative disc issues. If you were to grab a random 100 people off the street....you would see everything from bulgin discs....to bone spurs to narrowing of the space between the vertebrae.

    85% of people don't have many symptoms at all or if they do, they can be resolved on their own or with non surgical modalities.

    Surgery....especially a fusion....should be the absolute last thing when everything else has been tried and one's life is pretty much miserable with pain and nerve issues and this is needed. Unfortunately there are some cut happy surgeons out there that do fusions more for the practice...

    When you seek the 2nd and 3rd opinions...(again...from Board Certified Neurosurgeons that do NOT know one another)...ask them if they think this is an absolutely necessary surgery or if it's considered elective.

    Because you aren't having awful symptoms right now....you have TIME....Time to research more...Time to get more opinions...Time to really spend on all the non surgical means of treatment.

    Have you done rounds of Physical Therapy? Injections (Both steroid and lidocaine)? Traction? Acupuncture?

    Obviously none of us are medical professionals and just giving our own opinions...I'm basing mine on 11 years of living with spine issues and what I've learned from my Neurosurgeon and PM Dr. I have 3 severe herniations right now with one in my lower cervical/upper thoracic region and two in my lumbar. But my Neuro and I will only do surgery when there is direct threat of paralysis and we can't hold out anymore.

    For now I use exercise, yoga/stretching/aqua therapy, injections, traction, brace, ice, heat, massage, acupuncture, and medicines.

    Whatever you decide....keep us posted on your journey..

  • I had a fusion done at 5/6 for the same reason my spinal cord was compressed to 3 mm, over 2 1/2 months I lost most of the use of my legs and left side, I could walk with assistance tho. I had my surgery on aug 6 2010, for me it was like a light switch got turned on as all most all of my symptoms were gone after a few weeks. A little over a year later I fell & hit my head, this time I wasn't so lucky, I needed to have aditional fusions @ 4/5 6/7 7/t1on feb 23 2012, before surgery this time I was in a wheelchair and was rapidly losing the use of my left arm and other functions.
    Today I can walk without assistance, not well, but I can walk. Neither of my surgerys had any expectation of getting better, just not getting any worse. Getting better is just a bounus.

    Get other opinions and weigh your options, but be quick, severe cord compression can cause a lot of damage, & the longer you wait the less likely a full recovery can get.
  • Like mentioned, we don't have any medical knowledge, other than our own experiences. I have had neck "issues" since a rear end car accident when I was 18. I just lived with all the stiffness, aches and pains for years, just brushing them off. I finally couldn't hold my head up straight. The surgery took away most of the spasms and pain (felt like a large book was pushing my head down) but because of the years of assault on my spinal cord, my head turning ability is nill to the left and minimal to the right. You might not be too bad right now, but the damage will pile up over time. Go and get the 2nd and 3rd opinions for you own peace of mind. Also, I had an orthopedic surgeon that specialized in spinal surgeries. You might want to get one of your opinions from an orthopedic doctor. Also, with this healthcare package hanging over America's heads, surgery might not be available so readily.

    Good Luck and I hope you can get some excellent advice from several doctors.


    C1 - C2 PCDF 2003
  • Thank you everybody for your support comments. I talked to the neurosurgeon yesterday and a second opinion, they both recommended me to have the acdf done as soon as possible. I've looked at the MRI myself and comparing the normal canal size of the spine, it look very compressed with my untrained eyes. My first neurosurgeon was recommended by the neurologist; who himself used the same surgeon to do his ACDF last year when he had a 5mm compression left. This first surgeon was relaxed, a good feeling my wife and I got from him, 20+ experience and very knowledgeable staff; he recommended me to have a C4, C5 with fusion.

    The second opinion I got was from a different neurosurgeon, he recommended me to have a C4, C5 and C6 fusion. I'm not so sure about this second opinion, he looks like he just got out of school. He was showing my reflexes to the nurse like "look, this is called xyz". And never even explain to me what it meant until I ask him. He also had to take a phone call in the middle of it, and the nurse cell phone also ring during a different time. They first said they can get me in next Thursday, than later when I show no interest in getting the surgery done there, they offer Monday.

    Even the second opinion didn't seem that great, I had to call my first surgeon to ask him why not two levels; and he explained that he is on the conservative side, if I get two levels done, it put more stress on other levels. He also said he'll look at it again today and give me a call back. His staff also mention that if the disc is bulging (C5,6), it doesn't mean it need to be fused.

    So far, I'm very comfortable with the first surgeon and going to go with what he recommended. My surgery is tomorrow morning, please say a prayer for us. :)

  • Wow! To be told on Saturday that you need this surgery and then to have it on Friday. That is quick. It does sound like it is an urgent requirement though. The fact that your neurologist recommends this surgeon and used him himself, is a very good recommendation. You have to have confidence in your surgeon, and it is good that both you and your wife feel that way.

    I suggest that you get some bendy straws in and also a 'grabber' to pick things up. There is a thread here at the top of the back and neck surgery area, with information about useful things to have after surgery. You are not going to have time to do much shopping before surgery, but perhaps someone else can get some of the 'must have' items. Soft and easy to swallow foods are a must. People say that ice cream is very soothing. If you can't find this thread, let me know and I'll give you a link to it. Have you got lots of pillows to get yourself comfortable after surgery once you are home?

    I'll say a prayer for you and your wife and 'hope that you heal' quickly and smoothly.
    Do let us know how you get on.

  • I have numbness on both hands and fingers; I also found that one of my leg thigh doesn't feel the right temperature; when I sit on something cold, only my right leg feel the coldness and not the left.

    I've been told to get 1 level C4,C5 and second opinion was 2 levels C4, C5 and C6. The one that said 1 level is the surgeon that was recommended by the neurologist who have had the same surgery him self by him. The surgeon that recommended the 2 levels seem to try to rush me into surgery; just was a good vibe (my wife and I felt the same when talking to him).

    I'm very convinced now that I need the surgery and ready to go in tomorrow at 7am. I have never see any "medical" related matters in my life moved so fast, and my work is moving very fast to get me ready for medical leave. While I don't feel pain and just numbness, I still don't feel ill but looking at the world around me that everyone who have knowledge about this i very concern and moving very fast really prompted me that it is absolutely needed.
  • jellyhalljjellyhall Posts: 4,373
    edited 08/09/2012 - 12:15 PM

    I'll be thinking of you tomorrow.
    Hope that all will go well and I'll look forward to hearing from you once you are well enough to post again.

    Take care,
  • and that your pain is being kept under control.

    Hoping that you will be able to go home soon and that before long you will be able to post and let us know how you are doing.
  • Day 2 being at home. I can feel things in my finger tips again. The surgery went smoothly. Was a bit nervous since I never went under but the support and info from this forum really helped.

    I've been sleeping few hours here and there. Overall feeling rested and minimal amount of pain too. I've also asked the doctor to give me xanax to keep me relax along with the pain pills.

    Am I suppose to sleep flat on my bed? It felt weird after I got up but most rested thou, I just want to make sure Im doing the right thing.
  • It sounds like all has gone well and that your recovery is underway now.

    I can't comment on how you should sleep. I often read that after an ACDF people need to sleep in a recliner because lying down is very uncomfortable. If you haven't been give instructions on how to sleep it may be that however is comfortable is ok. If you are unsure, I suggest that you make a call to your surgeon to check. They expect to have some phone calls with questions in the early stages of recovery.

    Keep up the good healing!

  • wonderful to read that your home and everything seems to be going well for you. Please let us know how you are doing. Sometimes I wish mine was more of a must do now thing as I've had too much time to think about the operation. Mine is still months away or longer.
    laminectomy c4/c5 2008, ACDF c4-c7 Jan 20 2014 sched
  • I had exact same issue. Just numbness in my hands and some stiffness and soreness but overall ok. Had mri done on monday. Tuesday they called me back to say i only have 3mm. Refer me to surgeon who I saw thursday and they scheduled me right away for the following monday. They expressed urgency and I wanted to delay for at least 2 weeks because I am moving  but they would not budge. So when its at 3 mm am I at high risk for spinal cord injury?  I have 2 kids still in school and need to pack and all that but I feel like they give me no option.
    I have had symptoms for year and half now but I am fully functional so not sure if I need to rush like this.
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